0:01

As you've seen by some of my examples,

0:03

nasal bone fractures don't often occur in isolation.

0:07

They often have associated fractures.

0:10

Here's an example of a patient who has multiple,

0:15

"nasal bone fractures", as well as other

0:18

fractures. So if we look in the first image,

0:20

we see that the anterior nasal or maxillary

0:23

spine here has been fractured.

0:25

This is a fracture that is very easily demonstrated on sagittal

0:29

reconstructions as long as you do them with thin enough

0:32

sections. If it's too wide a section, unfortunately,

0:36

you may get partial volume averaging

0:38

and you may not see the fracture.

0:39

But this little spine here is referred to as the anterior

0:43

nasal spine or the anterior maxillary

0:45

spine or the maxillary spine.

0:46

And this is, again, part of that complex

0:49

of a nasal bone fracture,

0:50

even though it really doesn't involve

0:52

the nasal bones themselves.

0:54

Here you have a fracture that do involve the nasal bones,

0:57

not only of the nasal bones, but also

1:00

of that suture that I mentioned previously.

1:03

This little asterisk here,

1:05

which is demonstrating the nasomaxillary suture,

1:09

which is this structure, which is coming down right along here.

1:13

That's to be separated from the frontomaxillary suture, which we

1:19

will see in just a moment as part of the naso-orbito-ethmoidal

1:24

complex. So, fractures of the nasal bone as well

1:28

as the nasomaxillary suture. And here's,

1:32

the nasal bone fracture on the sagittal.

1:34

In addition,

1:34

you notice that this patient's anterior portion

1:38

of the maxillary antrum has been fractured.

1:41

But this anterior portion of the maxillary antrum is the common

1:45

wall with the orbital rim, as well as more posteriorly,

1:49

the orbital floor affecting the infraorbital nerve.

1:53

This fracture extends to involve the nasolacrimal duct.

1:58

So, what you're seeing

2:00

are these little areas right here and right here.

2:04

So let me remove the... and you can see the wall of the normal

2:11

nasolacrimal duct has been fractured

2:14

with a free fragment right here.

2:18

So that's the nasolacrimal duct fracture. A portion, again,

2:23

that we will talk to in just a moment about the naso-orbito

2:27

ethmoidal complex. And in addition,

2:30

the medial maxillary wall has been violated.

2:32

So multiple fractures, not just including the nasal bones.

Case 5 - Nasal Bone Fracture Summary

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video

0:01

As you've seen by some of my examples,

0:03

nasal bone fractures don't often occur in isolation.

0:07

They often have associated fractures.

0:10

Here's an example of a patient who has multiple,

0:15

"nasal bone fractures", as well as other

0:18

fractures. So if we look in the first image,

0:20

we see that the anterior nasal or maxillary

0:23

spine here has been fractured.

0:25

This is a fracture that is very easily demonstrated on sagittal

0:29

reconstructions as long as you do them with thin enough

0:32

sections. If it's too wide a section, unfortunately,

0:36

you may get partial volume averaging

0:38

and you may not see the fracture.

0:39

But this little spine here is referred to as the anterior

0:43

nasal spine or the anterior maxillary

0:45

spine or the maxillary spine.

0:46

And this is, again, part of that complex

0:49

of a nasal bone fracture,

0:50

even though it really doesn't involve

0:52

the nasal bones themselves.

0:54

Here you have a fracture that do involve the nasal bones,

0:57

not only of the nasal bones, but also

1:00

of that suture that I mentioned previously.

1:03

This little asterisk here,

1:05

which is demonstrating the nasomaxillary suture,

1:09

which is this structure, which is coming down right along here.

1:13

That's to be separated from the frontomaxillary suture, which we

1:19

will see in just a moment as part of the naso-orbito-ethmoidal

1:24

complex. So, fractures of the nasal bone as well

1:28

as the nasomaxillary suture. And here's,

1:32

the nasal bone fracture on the sagittal.

1:34

In addition,

1:34

you notice that this patient's anterior portion

1:38

of the maxillary antrum has been fractured.

1:41

But this anterior portion of the maxillary antrum is the common

1:45

wall with the orbital rim, as well as more posteriorly,

1:49

the orbital floor affecting the infraorbital nerve.

1:53

This fracture extends to involve the nasolacrimal duct.

1:58

So, what you're seeing

2:00

are these little areas right here and right here.

2:04

So let me remove the... and you can see the wall of the normal

2:11

nasolacrimal duct has been fractured

2:14

with a free fragment right here.

2:18

So that's the nasolacrimal duct fracture. A portion, again,

2:23

that we will talk to in just a moment about the naso-orbito

2:27

ethmoidal complex. And in addition,

2:30

the medial maxillary wall has been violated.

2:32

So multiple fractures, not just including the nasal bones.

Report

Summary

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Introduction

Introduction to Emergency Head, Neck & Spine Imaging

Clinical Scenario 1

Orbital Trauma/Inflammation

Clinical Scenario 2

Facial/Neck Trauma

Clinical Scenario 3

Sore Throat Pain and Fever

Clinical Scenario 4

Mass in the Neck

Clinical Scenario 5

Cervical Spine Trauma

Clinical Scenario 6

Fever, Back Pain

Clinical Scenario 7

Head & Neck Emergencies

Case 5 - Nasal Bone Fracture Summary